Family physician Britt Lehmann- Bender says the trauma training she received from Sunnybrook has helped her to handle medical emergencies that typically arise in rural practice, such as ATV or snowmobile accidents. (Photograph by Tim Fraser)
As a family doctor who works in Northern Ontario communities, Britt Lehmann-Bender is sometimes the only doctor handling what she calls “big and scary” situations: treating victims of snowmobile, ATV or motor vehicle accidents. So the 32-year-old jumped at the chance to take further training to help give her trauma patients the best possible care. Last fall, she took part in Ontario’s innovative Supplementary Emergency Medicine Experience choosing as her elective a two-week trauma rotation at Sunnybrook.
The program, which began as a pilot project in 2013 and has been running every spring and fall since September 2015, offers paid fellowships to family physicians practising in smaller or rural communities who want to build up their emergency-medicine skill set.
Participants spend three months in Toronto, completing two four-week placements in the emergency departments of Greater Toronto Area hospitals, with one day every week devoted to advancing their skills in classrooms and simulation labs. They get an additional month for clinical study, which they can spend either working in intensive care or in a two-week trauma rotation at either Sunnybook or St. Michael’s Hospital, usually complemented by two weeks of anaesthesia training. The program is funded by the University of Toronto’s Department of Family and Community Medicine and the Ontario Ministry of Health and Long-Term Care.
For Dr. Lehmann-Bender, who has spent one week a month working in remote Northern Ontario communities – including Neskantanga First Nation on Attawapiskat Lake – the rotation at Sunnybrook’s Tory Regional Trauma Centre was invaluable. She got to work with some of the country’s top trauma physicians at Ontario’s leading centre for the treatment of the province’s most critically injured patients. Given that Sunnybrook gets three to four new trauma cases daily, she was able to treat patients in much worse shape than any she’d seen before. She carried out procedures that were new to her, such as putting in an arterial line (for monitoring blood pressure continuously and extracting blood samples).
“It’s been easy for me to go back [to my practice] and, when I have to manage traumas, to think of the multitude of experiences with various traumas I had at Sunnybrook,” Dr. Lehmann- Bender says. “You’re not having a stress response because you’ve done something a few times and you’re comfortable managing similar things. It has helped me be calm.”
Dr. Avery Nathens, Sunnybrook’s surgeon-in-chief and trauma medical director, says the hospital’s trauma elective helps to fill the experience gap for physicians outside of big cities, who might see just a single critically injured patient every year.
In addition to developing their technical expertise, it enhances their confidence.
“If you’ve never taken care of a patient like this, it’s easy to become overwhelmed, and the most important thing is to keep your wits about you, so you can focus on the priorities. And having done this on a rotation five or six times a day, they get pretty confident at being able to focus on the patient’s needs and move the care plan forward.”
Sunnybrook is an ideal place for learning about treatment of critically injured patients. “We have extremely high trauma volumes and are the largest trauma centre in Canada,” says Dr. Nathens, who holds the De Souza Chair in trauma research. “We probably see about 1,300 severely injured patients a year. Patients come to us with a variety of different problems. Our location in the city means we encounter victims of high-speed crashes or interpersonal violence, which challenge providers in different ways.”
Dr. Homer Tien, a Sunnybrook trauma surgeon who helped to create the trauma rotation for the program, notes that participants work on procedures in a simulation lab but also get a lot of hands-on clinical experience. “They also shadow one of the established trauma team leaders, and they can watch how he or she runs the case and then slowly take over. And there’s a comfort level in knowing that you have the backup of someone more experienced to help you in case you run into a difficult situation.”
In addition, says Dr. Nathens, there are lessons to be learned from reviewing patient care. “Every morning, we have what we call ‘morning report,’ where we review each patient in detail and review care plans. It also provides a great opportunity for teaching to build on the experiential learning that takes place in the trauma bay.”
Military doctors gain confidence through Sunnybrook’s trauma education
Dr. Rob Riddell, a military physician with the rank of Major with Special Operations Forces in the Canadian military, says his trauma rotations at Sunnybrook proved to be tremendously beneficial during a recent deployment overseas.
“I was able to apply all of the skills that I learned at Sunnybrook to severely injured battlefield trauma patients, a significant amount of patients with penetrating injuries, blunt trauma, head injuries and everything in between. I’d say my decision making is much, much more enhanced than it ever would have been had I not gone to Sunnybrook.”
Sunnybrook began offering trauma rotations to Canadian Forces physicians in 2012. These sessions – a six-week turn for medical residents and a two-week refresher for physicians about to deploy or in high-readiness units – were launched by Sunnybrook trauma surgeon Dr. Homer Tien, a former senior trauma physician in the Canadian military who spent almost a year in Afghanistan.
“These doctors need to be able to manage major trauma cases and to maintain this clinical readiness throughout their military career,” says Dr. Tien, who holds the rank of Colonel. “Sunnybrook’s Tory Regional Trauma Centre helps them do this.”
For Dr. Riddell – who was among the 17 candidates in contention to become Canadian Space Agency astronauts – his comfort level and confidence in managing severely injured people have “gone up tenfold. It’s freed up breathing space, which was sometimes taken up too much by stress and allows me to think a little more clearly.”